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Issued by

Office of Research on Women's Health (ORWH)

Office of AIDS Research (OAR)

Purpose

The NIH Office of Research on Women’s Health (ORWH) and Office of AIDS Research (OAR), in partnership with our Institute, Center, and Office (ICO) partners are issuing this Notice of Information to provide a centralized list of opportunities in HIV research and training grant applications that explicitly and intersectionally center the health needs of cisgender women and girls, and gender-diverse people.

Despite tremendous scientific advances that have translated to substantial progress in confronting the HIV epidemic, women—particularly women of color, young women and girls, and transgender women—and gender-diverse individuals remain disproportionately affected by HIV. An intersectional, equity-informed, data-driven approach is essential to advance HIV research and clinical care for all women with or impacted by HIV across their lifespan and to end the HIV pandemic (Barr et al, 2024).

Background

According to UNAIDS, women and girls accounted for more than half (53%; 20.7 million) of the 39 million people with HIV and 46% of new acquisitions in 2022 with approximately 4,000 adolescent girls and women (AGYW) aged 15-24 years acquiring HIV on a weekly basis. Worldwide in 2022, median HIV prevalence among transgender people was 10.3% (UNAIDS) and transgender women experience a 14-fold higher chance to acquiring HIV than their cisgender peers (Stutterheim 2021). Although 82% of the 1.3 million pregnant women with HIV receive antiretroviral therapy to prevent perinatal transmission, breast/chest-feeding is complicated by HIV status. The WHO estimates 1.22% of maternal deaths worldwide are HIV-related and pregnancy in women with HIV is complicated by an increased association with comorbidities resulting in a 2-10-fold increased chance of mortality (Calvert et al, 2013; Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division)

In the United States and dependent areas, data from the Centers for Disease Control and Prevention indicate that over 250,000 women were living with HIV and more than 5,000 women newly acquired HIV in 2020. Black and African American women accounted for 54% of new diagnoses among females despite only comprising 13% of the female population. An estimated 44% of Black and African American transgender women and 26% of Latinx transgender women in the United States are living with HIV (Becasen et al., 2019). New HIV acquisitions were highest among women aged 25 to 34 years. Approximately 54% of women with HIV in the United States are over the age of 50. CDC analyses report that HIV acquisition among women 55 and older increased 7% from 2015-2019, further demonstrating that women with HIV are aging, and aging women remain vulnerable to HIV.

Insufficient consideration of sex, gender, and their intersections in health as well as limited inclusion of women and gender-diverse people in health research reduces the availability and accessibility of safe and effective HIV prevention, treatment, and cure modalities (Curno et al., 2016; Pepperrell et al, 2020; NASEM, 2022). Prioritizing the inclusion of diverse populations of women in prevention, therapeutic, and cure-related research is an essential component of ending the HIV epidemic.

Informed by responses received to a Request for Information (NIH Request for Information [RFI] on Research Opportunities Related to HIV and Women’s Health; NOT-OD-24-011) and analyses of the NIH HIV research portfolio (NIH HIV and Women’s Health Topical Portfolio Analysis), this Notice of Information highlights key opportunities of high interest at the intersection of HIV and women’s health.

Research approaches centered on women and gender-diverse people

• Community-engaged/focused research
• Projects to develop, test, and evaluate approaches to increase and facilitate women’s participation in research (e.g., transportation support, childcare, expanded hours)
• Community-engaged research focused on women and gender-diverse people from understudied, underrepresented, and underreported (U3) populations
• Projects to improve community engagement and community-led research
• Behavioral and social science research (BSSR)
• Qualitative, arts-based, and interdisciplinary research projects
• Equity-informed research to address health disparities across the life course
• Implementation science research to promote the systematic uptake of tailored, evidence-based HIV interventions and delivery approaches
• Projects to evaluate the effect of local, state, and federal policies (e.g., HIV criminalization laws, anti-transgender legislation, abortion restrictions, ending of affirmative action, pre-exposure prophylaxis [PrEP] coverage, Medicaid expansion) on health of people with HIV
• Observational, woman-focused cohorts and projects to leverage existing cohorts to answer woman-specific questions
• Research on effective models of HIV-related science and public health communications that reflect community input and are culturally appropriate for women and gender-diverse people with and impacted by HIV
• Ethical, legal, policy, and social science analyses focused on improving research inclusion/participation, alleviating barriers to the uptake of research findings, or mitigating potential disparities in outcomes

HIV prevention

• Methods and approaches to increase access to HIV prevention, including post-exposure prophylaxis (PEP), PrEP and multipurpose prevention technologies
• HIV prevention interventions for Black and African American women in the United States
• Methods and approaches to integrate interventions which simultaneously address social, structural, institutional, and behavioral barriers to HIV prevention and care
• HIV prevention focused on social, behavioral, and structural risk factors (e.g., access to culturally competent HIV care services, child maltreatment, trauma, mental illness, stress, alcohol and substance use, etc.)  
• Effects of intersectional stigma on HIV prevention and interventions to address intersectional stigma

HIV treatment

• Gender-affirming and trauma-informed HIV care and research
• Sex and gender considerations related to polypharmacy, and drug-drug interactions
• Developing and testing interventions to expand access to and maintenance of HIV treatment
• Long-term effects of gender-affirming hormone therapy (GAHT) and HIV therapy

Comorbidities and multimorbidity in the context of HIV

• Female-specific conditions (e.g., fibroids, endometriosis, pelvic inflammatory disease)
• Prevalence, biological mechanisms, and clinical risk factors responsible for the development of gynecologic pain syndromes in women and gender-diverse people with HIV and taking PrEP
• Malignancies, including gynecologic and female-predominant cancers (e.g., breast, uterine, cervical and vaginal cancers)
• Cardiovascular, pulmonary, hepatic, bone, renal and neurocognitive disease
• Autoimmune diseases and HIV
• Alcohol, tobacco, and other drug use in the context of HIV Mental health comorbidities, including trauma,
• Studies to develop and evaluate the efficacy of integrated care models for management of HIV and co-occurring conditions in women and gender-diverse people.

HIV cure-related research

• Understanding the influence of sex and gender on HIV reservoirs, including the central nervous system
• Role of sex and gender in HIV cure-related research
• Community-centered interventions to engage diverse populations of women (e.g., older women, women of color, rural women) and gender-diverse people in HIV cure-related research
• Woman-centered behavioral and social science approaches to cure-related research
• Projects to enhance diversity in cure-related research, including geographic diversity (e.g., projects engaging women and girls in Africa)

Life-course approaches in the context of HIV

• Maternal health, including the intersection of HIV, pregnancy, and comorbidities impacting maternal morbidity and mortality
• Sexual and reproductive health, including contraception
• HIV treatment and prevention during pregnancy, lactation, and the postpartum period
• Consequences of perinatal and/or early childhood exposure to HIV and/or antiretrovirals
• Multidisciplinary research to develop clinical, behavioral, and social interventions to effectively prevent and treat HIV and address comorbidities, coinfections, and complications of long-term HIV and its treatment across the lifespan
• Projects to address the unique social and clinical needs of lifetime survivors and long-term survivors including people with perinatally acquired HIV
• Projects to address the unique needs of people with perinatally acquired HIV and their transition from pediatric to adult HIV care
• Menopause among women with HIV, including symptoms and conditions associated with estrogen loss, mood and sleep disturbance, cognitive function, bone and CVD, hot flashes, and quality of life
• Effects of HIV and ART/PrEP use on menstruation, perimenopause, and/or the menopausal transition
• Projects to understand and address weathering, social isolation, stigma, and loneliness in the context of HIV and aging
• Projects to understand and develop practical socio-behavioral, biomedical, and integrative approaches to needs and opportunities for women to thrive and/or maintain/improve their quality of life in the context of HIV that applies to them (e.g., biological profile, social determinants of health, intersectionality), across the lifespan.
• Community-led interventions to improve HIV testing, prevention, and treatment among older populations of women and gender-diverse people
• Understanding the influence of sex-linked biology on HIV infection and pathogenesis in the context of aging
• Understanding the role of HIV in violence, trauma, and mental health in aging women and gender-diverse people with HIV

Social and structural considerations in the context of HIV

• Development and testing of comprehensive, woman-centered programs to address HIV and sexual and reproductive health
• Studies that investigate social determinants of health, including their interactive properties, that contribute to HIV health disparities for Black and African American cisgender and transgender women and other women of color
• Studies to develop and examine interventions that address social, structural, institutional, and behavioral barriers to HIV prevention and care including justice system involved settings
• Projects to understand, address, and intervene upon gender-based violence and intimate partner violence including justice system involved settings
• Resilience-focused interventions
• Studies to explore the economic and other power levers that impact women's health
• Gender roles, norms, and power
• Projects to understand and develop interventions to address discriminatory HIV-related socio-structural factors, policies, laws, and norms that serve as barriers to HIV prevention, treatment, and care, both on an individual as well as on the macro-level (e.g., community, specific demographics or groups, etc.) at local and national levels.
• Projects to understand and develop intervention tools to improve health communications, including effective ways to prevent and/or mitigate the effects of HIV-related disinformation and malinformation campaigns and other similar efforts.
• Projects to enhance understanding of the relationship between sex work and HIV outcomes

Training, career and workforce development considerations in HIV-related research

• Programs to promote the entry, recruitment, retention, and sustained advancement of women and gender-diverse people in research careers
• Programs to promote re-entry, reintegration into, and retraining of women in research careers
• Programs to build capacity of clinicians specialized in culturally competent, person-centered HIV-related care for women and gender-diverse people
• Programs to build the capacity of underrepresented women of color to become independent researchers
• Programs to build research capacity in diverse settings and in institutions with limited resources

Inquiries

Please direct all inquiries to:

Elizabeth Anne Barr, Ph.D.
Office of Research on Women’s Health (ORWH)
Telephone: 301-402-7895
Email: elizabeth.barr@nih.gov

Leslie Marshall, Ph.D.
Office of AIDS Research (OAR)
Telephone: 301-402-1839
Email: Leslie.marshall@nih.gov